Aseptic and Clean Technique

Transcription

1 Aseptic and Clean Technique Asepsis means the absence of potentially pathogenic microorganisms and applies to both medical and surgical procedures. Medical asepsis aims to prevent transmission by applying standard principles of infection prevention including hand decontamination, use of PPE and not touching susceptible sites or the surface of medical devices. Surgical asepsis is more complex, including procedures to eliminate microorganisms from an area. Aseptic technique is applied to a set of specific practices and procedures to assure asepsis and prevent the transfer of potentially pathogenic microorganisms to a susceptible site on the body. Where these are performed: clinical procedures should be carried out in a manner that maintains and promotes the principles of asepsis; education, training and assessment in the aseptic technique should be provided to all persons undertaking such procedures; the technique should be standardised across the organisation; and audit should be undertaken to monitor compliance with the technique. Principles of aseptic technique An aseptic technique should be implemented during any invasive procedure that bypasses the body s natural defences e.g. skin, mucous membranes, or when handling equipment such as intravenous and urinary catheters. An aseptic non touch-technique, ANTT (i.e. being able to identify the key parts of any procedure and not touching them directly or indirectly), is an important component of achieving asepsis. It is important to prevent contamination of all sterile equipment Indications for using an aseptic technique include: Dressing of wounds healing by primary intention e.g. surgical incisions and burns. Peripheral cannulation. Urinary catheterisation. Suturing. Removal of drains. Medical invasive procedures e.g. minor surgery. All infection prevention and control standard precautions must be implemented in conjunction with a correct aseptic technique to ensure the prevention of infection, i.e. Hand washing/decontamination/surgical scrub. Clean, safe and appropriate environment in the procedure area. All cleaning activities must be suspended whilst aseptic techniques are in progress.

2 Clean/sterile equipment and maintaining a sterile field. Use of personal protective equipment e.g. gloves, aprons, surgical attire, Correct patient preparation, including information required on the process to be performed. There is no UK standard for aseptic practice, or for teaching aseptic practice and therefore practice is highly variable. The following guidance is adapted from the evidence based Clinical Nursing Procedures from the Royal Marsden Hospital (2008) and provides a standardised procedure that all staff should follow. In the past, many aseptic techniques included a ritualistic practice of cleaning trolleys with alcohol between clients. It is now felt that this serves no useful purpose, and that a trolley cleaned with detergent and hot water or general purpose detergent (GPD) hard surface wipes and dried with paper roll is sufficient, as the sterile field will be created by the sterile towel contained within the dressing pack. Equipment required 1. Sterile dressing packs; containing gallipots or indented plastic tray, low-linting swabs 2. Fluids for cleaning/irrigation 3. Hypo-allergenic tape 4. Appropriate sterile wound dressing 5. Appropriate hand hygiene preparation (e.g. alcohol gel, only to be used after hand washing and during procedure if hands not soiled) 6. Other equipment; e.g. sterile scissors, catheter etc. 7. General purpose detergent wipes (GPD) for cleaning trolley 8. Patient record forms for batch numbers of equipment to be recorded etc.

3 Procedure for aseptic non touch technique (ANTT) 1. Explain and discuss procedure with patient 2. Wash hands with liquid soap and dry on paper towels 3. Clean trolley and wash hands 4. Place all equipment required on bottom shelf of the clean dressing trolley 5. Take patient to the treatment area and expose the area to be treated whilst maintaining patient s dignity and comfort 6. Don plastic apron 7. Take trolley to treatment area 8. Loosen dressing tape if necessary 9. Decontaminate hands with alcohol hand rub 10. Check pack is dust free and sterile, open pack and slide the contents onto the top shelf of the trolley 11. Open sterile field using only the corners of the paper 12. Open other packs as required and tip contents gently onto sterile field 13. Decontaminate hands with alcohol hand rub Place hand in sterile disposable bag from pack, arrange contents of dressing 14. pack on the sterile field (NB some packs do not contain a bag and so an additional pack will be required containing a spare sterile field, gloves and a bag) 15. Remove used dressing, if necessary, with hand covered with the disposable bag, invert bag and stick or clip to trolley 16. Decontaminate hands with alcohol hand rub 17. Where appropriate swab tear area of lotions with chlorhexidine/alcohol saturated swab, tear open and pour lotion into a gallipot/tray 18. Put on sterile gloves, touching only the inside wrist end

4 Carry out procedure Any equipment that becomes contaminated during the procedure must be discarded. 1. Make sure patient is comfortable Dispose of clinical waste in clinical waste bag and all other waste e.g. outer bag 2. wrappings into domestic waste. Remove gloves and apron, dispose in clinical waste 3. Clean trolley with general purpose detergent (GPD) and dry 4. Wash hands 5. Write records, including adding sterility labels/batch numbers of equipment NB Different types of sterile packs may be required depending on the procedure to be performed e.g. wound dressing, catheterisation Clean technique (modified aseptic technique) In some situations, a modified aseptic clean technique is more appropriate. The aim is still to avoid the introduction of potential pathogens to a susceptible site and to prevent the transfer of pathogens to other patients or staff but wounds that may be dressed with a clean technique may already be heavily colonised by bacteria. A risk assessment must be taken to ensure this process is appropriate for the type of wound being dressed. The basic principles of an aseptic technique must be adopted and sterile dressing materials used: Clean gloves rather than sterile are acceptable Good quality potable (drinking) water rather than sterile saline is acceptable for cleansing traumatic wounds and leg ulcers Indications for use of a clean technique may include: Dressing of wounds healing by secondary intention Removal of sutures Dressing tracheostomy sites Stoma care

5 Leg ulcer clinic A risk assessment of the use of the room must be performed. If the room is to be used for leg ulcer care other invasive procedures should not be performed in this room e.g. podiatry, coil clinics etc. until the room has been thoroughly cleaned. A monitored cleaning schedule must be implemented. Staff must ensure that all surfaces are cleaned in between each patient with disposable cleaning products. The room should have flooring and wall coverings that are washable, impervious and sealed. There must be: a dedicated hand washbasin; a deep sink or drain to pour away contaminated liquids (or nearby toilet may be used); a washable, impervious couch/chair; sufficient cupboards to store all equipment with no clutter on any horizontal surfaces (no open shelves etc.). If a showerhead is used, this should be incorporated above a floor mounted butler sink to allow the patients feet to be placed into the sink, whilst the shower is used to hose/soak the dressings. This butler sink should be connected to a mains drainage exit. The staff must wear personal protective clothing (including visor if a shower-head is to be used). If the showerhead is not being used a dedicated bowl/bucket (that allows the whole foot to be placed at the bottom of the container to prevent accidental spillage) must be used. A single-use plastic, impermeable lining bag should be placed in the container before filling with water, and the container decontaminated and a new bag fitted between each client. All equipment must be decontaminated using general-purpose detergent and hot water or GPD hard surface wipes and then dried, after each use. Patient specific pots/tubes of cream and bandages must be used. Only one patient should be cared for at any one time in the leg ulcer room. The Royal Marsden Hospital Manual of clinical procedures. 9 th Edition. Blackwell and Wiley 2015